Going the Distance

University of Maryland Rounds features clinical and research updates from the University of Maryland School of Medicine and the University of Maryland Medical Center.

Intended for physicians, Rounds contains contact information to learn more about the clinical and research advances featured in each issue. It is printed three times a year and distributed monthly via email.

After a horrific accident nearly killed Seattle resident Elisa Hays, she wasn’t about to be deterred by a local hospital’s refusal to perform a kidney transplant on her using her brother’s donated kidney. So Hays gratefully made the cross-country trek to University of Maryland Medical Center (UMMC), which has long touted the ability to transplant kidneys like her brother’s — with multiple renal arteries instead of a single artery — and continually attracts similar patients from around the nation for this technically challenging procedure.

The living donor transplant spotlights UMMC’s unusual capabilities in offering multiple renal artery kidney transplants, which have been performed here since Chairman of Surgery Stephen T. Bartlett, MD, arrived nearly a quarter-century ago. Kidney transplants using live donors with multiple renal arteries, an otherwise harmless anatomical irregularity affecting small numbers of people, comprise only about a dozen of the many hundreds of total kidney transplants done at UMMC each year, Dr. Bartlett says.

But the expertise required to accomplish this complex surgery isn’t available at many other centers around the country, even those that also have high-volume kidney transplantation programs. Dr. Bartlett, also the senior vice president and surgeon-in-chief for the University of Maryland Medical System, is a board-certified vascular surgeon and skilled in microsurgery — which is crucial to multiple renal artery kidney transplants.

“It’s common for people to come to us after having been turned down by other centers because their donor has too many renal arteries,” explains Dr. Bartlett, the Peter Angelos Distinguished Professor of Surgery at University of Maryland School of Medicine. “That’s where UMMC has excelled, using our technical skills to use kidneys that are anatomically challenged. We have been able to go above and beyond, and that’s why people seek us out.”

Safely Expanding the Limits

But with each additional renal artery extending from a donor kidney, a transplant using the organ becomes more technically challenging. While a typical renal artery measures 5 to 6 millimeters in diameter, the arteries in kidneys with multiple vessels tend to be progressively narrower, thus requiring microsurgery to successfully attach the kidney to a recipient’s blood supply, Dr. Bartlett explains. Using kidneys with multiple renal arteries is one approach to expanding the donor pool for kidney transplantation, since donor organs are chronically in short supply. More than 100,000 people are awaiting kidney transplants in the United States, and the average wait time is more than 3.6 years. In 2014, about one-third of the 17,000 kidney transplants taking place in the United States came from living donors, according to the National Kidney Foundation.

Not only are the grafts much smaller, but a donor kidney with multiple renal arteries takes longer to transplant — a situation that can be extremely hazardous to the kidney, since time is of the essence in keeping the organ viable. Dr. Bartlett solves this problem by taking a piece of the recipient’s saphenous vein in the leg — “a very good arterial substitute” and also used in cardiopulmonary bypass procedures — and splicing it to the donor organ to create a single, larger renal artery.

About 15% of kidneys have two arteries, he says, while 1% to 2% have three arteries and another 1% have four.

“We’ve expanded the limits and have been able to do so safely,” Dr. Bartlett says. “Our outcomes are outstanding, and we’ve never had a donor death in 24 years.”

Winding Road Leads Seattle Patient to UMMC

Hays, 48, had not been expected to live and was subsequently hospitalized for four months after being struck by a semi truck on an icy interstate highway in Oklahoma in March 2014. After 20-plus surgeries, months of rehabilitation and lasting kidney failure stemming from the accident and aftermath, Hays’ doctor said her kidneys would never fully recover and she would need a transplant if she wanted to stay off dialysis treatments. Her brother was deemed a good match, but because he has three renal arteries, the Washington State Hospital said they could not do the transplant. That’s when the family found the University of Maryland.

‘No Doubt We Made the Right Choice’

Dr. Bartlett scheduled Hays’ surgery and all went well, with her brother’s left kidney grafted into Hays’ right side. “All of a sudden, I had a working kidney. It was absolutely magical,” says Hays. “I’m so glad we went to Baltimore. My family said there’s no doubt we made the right choice.”

Hays’ case was all in a day’s work for Dr. Bartlett! “We’re a center dedicated to technical excellence,” he says. “We have some of the best protocols in the country, which sets UMMC apart because we’re a place willing to take on types of cases other centers aren’t able to handle. We’re able to go above and beyond the routine.”

To learn more about the kidney transplant program, please call 410-328-5408.